Journal of Clinical Nursing Impact Factor & Information

Publisher: Wiley

Journal description

Journal of Clinical Nursing is the ideal information resource for nurses everywhere seeking to enhance their practice. Focusing directly on the theory and practice of nursing and highlighting matters of concern to practising nurses, Journal of Clinical Nursing covers important issues such as: the developing role of nurses and those who assist them; the relationship of nursing theory to current practice; methods of assessment, planning, intervention and evaluation; the clarification of concepts relevant to nursing practice; the organization of clinical nursing work; the nature of clinical nursing expertise; quality assurance in nursing; teamwork in health care; the integration of clinical, educational and research work.

Current impact factor: 1.26

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 1.255
2013 Impact Factor 1.233
2012 Impact Factor 1.316
2011 Impact Factor 1.118
2010 Impact Factor 1.228
2009 Impact Factor 1.194
2008 Impact Factor 1.376

Impact factor over time

Impact factor

Additional details

5-year impact 1.70
Cited half-life 6.10
Immediacy index 0.19
Eigenfactor 0.01
Article influence 0.48
Website Journal of Clinical Nursing website
Other titles Journal of clinical nursing (Online)
ISSN 1365-2702
OCLC 45498353
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • On author's personal website, institutional repositories, arXiv, AgEcon, PhilPapers, PubMed Central, RePEc or Social Science Research Network
    • Author's pre-print may not be updated with Publisher's Version/PDF
    • Author's pre-print must acknowledge acceptance for publication
    • Non-Commercial
    • Publisher's version/PDF cannot be used
    • Publisher source must be acknowledged with citation
    • Must link to publisher version with set statement (see policy)
    • If OnlineOpen is available, BBSRC, EPSRC, MRC, NERC and STFC authors, may self-archive after 12 months
    • If OnlineOpen is available, AHRC and ESRC authors, may self-archive after 24 months
    • Publisher last contacted on 07/08/2014
    • This policy is an exception to the default policies of 'Wiley'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims and objectives: To investigate which aspects of student nurses' experiences of residential aged care facility clinical placements affect perceived likelihood of choosing a career in residential aged care post graduation. Background: Poor clinical placement experiences as a student contribute to nurses' reluctance to work in aged care. Various factors have been found to improve the placement experience and influence students' attitudes and employment intentions. Missing from the literature is a quantitative - rather than qualitative - exploration of which attributes of an aged care placement link to perceived likelihood of working in residential aged care post graduation. Design: Supported residential aged care placement programmes were developed for nursing students using an evidence-based best-practice model within an action research framework. Staff formed a mentor group in two facilities. During placement, weekly feedback meetings were held for students and mentors. Methods: Second-year nursing students (n = 71) participating in a three- or four-week placement programme at two Tasmanian residential aged care facilities (September 2011-May 2013) completed questionnaires on placement experiences. Measures of association (correlation coefficients) were used to assess the effect of a range of variables on the likelihood of working in an aged care facility post graduation. Results: Associations were identified between the likelihood of working in residential aged care post graduation and nurse mentor-student feedback exchange, Teaching and Learning Score and supportiveness of care workers. Conclusions: This study adds to the literature by providing quantitative evidence that certain aspects of aged care placements influence attitudes to working in these sites post graduation. Relevance to clinical practice: To increase interest in working in residential aged care, the teaching and learning environment needs improvement, opportunities should be proffered for mentor-student feedback exchange during placements and care workers need support to mentor effectively.
    Journal of Clinical Nursing 11/2015; DOI:10.1111/jocn.13018
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    ABSTRACT: Aims and objectives: Evaluate continuous vital sign surveillance as a tool to improve patient safety in the medical/surgical unit. Background: Failure-to-rescue is an important measure of hospital quality. Patient deterioration is often preceded by changes in vital signs. However, continuous multi-parameter vital sign monitoring may decrease patient safety with an abundance of unnecessary alarms. Design: Prospective observational study at two geographically disperse hospitals in a single hospital system. Methods: A multi-parameter vital sign monitoring system was installed in a medical/surgical unit in Utah and one in Alabama providing continuous display of SpO2 , heart rate, blood pressure and respiration rate on a central station. Alarm thresholds and time to alert annunciations were set based on prior analysis of the distribution of each vital sign. At the end of 4 weeks, nurses completed a survey on their experience. An average alert per patient, per day was determined retrospectively from the saved vital signs data and knowledge of the alarm settings. Results: Ninety-two per cent of the nurses agreed that the number of alarms and alerts were appropriate; 54% strongly agreed. On average, both units experienced 10·8 alarms per patient, per day. One hundred per cent agreed the monitor provided valuable patient data that increased patient safety; 79% strongly agreed. Conclusions: Continuous, multi-parameter patient monitoring could be performed on medical/surgical units with a small and appropriate level of alarms. Continuous vital sign assessment may have initiated nursing interventions that prevented failure-to-rescue events. Nurses surveyed unanimously agreed that continuous vital sign surveillance will help enhance patient safety. Relevance to clinical practice: Nursing response to abnormal vital signs is one of the most important levers in patient safety, by providing timely recognition of early clinical deterioration. This occurs through diligent nursing surveillance, involving assessment, interpretation of data, recognition of a problem and meaningful response.
    Journal of Clinical Nursing 11/2015; DOI:10.1111/jocn.13102
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    ABSTRACT: Aims and objectives: To present findings from a qualitative study which aimed to explore and describe experiences of enjoyment in nursing. Background: The topic of 'enjoying nursing' is often part of job satisfaction surveys conducted in the workplace and in some studies it has been found to be the prime reason that nurses stay in the workforce. However, there is little research which explores the concept fully. Design: Qualitative in-depth interviews. Method: Semi-structured individual interviews were conducted with 17 nurses in a local health district in Sydney, Australia. Data from digitally recorded individual interviews were transcribed and the content was analysed for themes relating to aspects of nursing that were enjoyable and others that were not. Results: The major themes to emerge from the data describing enjoyment of nursing were: doing for others, supporting others and educating others. Themes that identified not enjoying nursing were related to the aggression of others, i.e. patients/clients, families or other staff in the workplace, as well as system issues. System issues referred mainly to the need for support from other nurses and management. Conclusion: Nurses still enjoy caring for patients and teaching others to care. This is the reason they remain in nursing even though the system and people are not always supportive or encouraging. Relevance to clinical practice: Managers and educators can use these results to assist them to understand the importance of giving support to nursing staff to optimise their enjoyment of caring for their patients/clients.
    Journal of Clinical Nursing 11/2015; DOI:10.1111/jocn.12981
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    ABSTRACT: Aims and objectives: Assess knowledge concerning methotrexate in rheumatoid arthritis patients by means of a questionnaire. Background: Methotrexate is the standard drug for rheumatoid arthritis treatment. It has potentially serious side effects that can be largely prevented by making sure that patients are well informed and comply with prescription guidelines. Design: Cross-sectional survey. Methods: A questionnaire on methotrexate (mode of action, administration, drug interactions), side effects, monitoring and lifestyle implications was offered to all the rheumatoid arthritis patients treated with the drug seen between March and September 2013 in a large hospital in France. Results: One hundred and eighty-three patients (143 women), mean age 60 (13·5) years, with a median disease duration of 12 years [7-20] and treated with methotrexate for eight years [5-13] took part. Methotrexate was identified as a disease-modifying antirheumatic drug by 78% of the patients. The weekly administration method was well assimilated (97%); 67% indicated that the rationale for folic acid was to reduce treatment toxicity. Only 21% knew that trimethoprim was contraindicated. Half were aware of the haematologic risk and 36% were aware of the risk of hypersensitivity pneumonitis. There was knowledge concerning laboratory testing (80%), but 54% thought they were only being monitored for rheumatoid arthritis activity. Only 13% of the men, but 90% of the women, of childbearing age knew that contraception was essential, and 75% indicated that alcohol consumption should be limited. A low knowledge score correlated significantly with age and low educational level. It was independent of sex, duration of treatment for rheumatoid arthritis. Conclusions: Rheumatoid arthritis patient's knowledge concerning methotrexate is poor, particularly for the most serious side effects (haematologic and hypersensitivity pneumonitis), interactions with trimethoprim, and in men, the need for contraception. Relevance to clinical practice: Patient knowledge concerning methotrexate should be regularly checked and supported using the different therapeutic education tools available, especially when patients are older people and have had limited schooling.
    Journal of Clinical Nursing 11/2015; DOI:10.1111/jocn.12999
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    ABSTRACT: Aims and objectives: To compare drug adherence to lipid-lowering therapy among outpatients with coronary artery disease who received information via short message service, via short message service and Micro Letter, or via phone only. Background: Messaging applications and short message service are commonly used internationally. However, little is known about how coronary artery disease outpatients in China may benefit from receiving health education through these technologies. Design: Random sampling method. Methods: Data were collected from March-December 2013. Subjects from Chengdu City, China, were randomised to three groups: short message service, short message service + Micro Letter, and phone (control). Appointment reminders and health information were delivered to patients in accordance with designations. After six months, adherence to statin prescriptions was compared among the groups by using the Morisky Medication Adherence Scale. Logistic regression analysis was applied to determine those independent variables that were related to adherence. Results: The short message service and short message service + Micro Letter groups had better cumulative adherence (lower Morisky Medication Adherence Scale scores) after six months than phone group, and the short message service + Micro Letter group had better cumulative adherence (lower Morisky Medication Adherence Scale scores) than the short message service group. Female sex, older age and marriage show positive associations with adherence. Conclusions: Short message service and messaging applications, such as Micro Letter, are effective means of providing discharged patients with reminders and coronary artery disease-related health information. Implementation of a short message service + Micro Letter program can improve outpatient adherence to medication. Relevance to clinical practice: This research offers useful information to help medical staff design effective interventions to improve medication compliance among coronary artery disease patients.
    Journal of Clinical Nursing 11/2015; DOI:10.1111/jocn.12988
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    ABSTRACT: Aims and objectives: A systematic review of published studies on service user involvement in undergraduate, preregistration general nursing education (excluding mental health-specific programmes). The objective is to examine how students are exposed to engagement with service users. Background: The requirement of service user involvement in all nurse education is policy expectation of health professional education providers, in response to the increased public and political expectations. Previous literature reviews have focused solely on mental health. Design: Systematic review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines; timeframe 1997-2014; published in English. Methods: Search of CINAHL, Cochrane Review, Education Research Complete, Internurse, MEDLINE, PsychINFO, Scopus, SocINDEX and Web of Science yielded 229 citations; 11 studies met the review eligibility criteria. Results: Seven studies used qualitative methodology, two quantitative and two mixed methods. Studies from the United Kingdom dominated (n = 9), the remainder from South Africa and Turkey. The results are described using four themes: benefits and limitations of service user involvement; nursing student selection; education delivery; practice-based learning and assessment. Most studies were small scale; nine had less than 30 participants. Overall the evidence suggests that student, lecturers and service users valued service user involvement in nurse education, to provide an authentic insight into the illness experience. Logistical considerations around support and student cohort size emerged. Conclusions: This is the first systematic review to focus on service user involvement in general nurse education. It reveals that service user involvement commenced later and is more limited in general programmes as compared to equivalent mental health education provision. Most of the evidence focuses on perceptions of the value of involvement. Further research is required to more clearly establish impact on learning and clinical practice. Relevance to clinical practice: Service user involvement in nurse education is valued by stakeholders but preparation and support for those involved, including mentors is underestimated.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13068
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    ABSTRACT: Aims and objectives: The Aims of this study were to explore the effects of nurses' attitudes and intentions regarding medication administration error reporting on actual reporting behaviours. Background: Underreporting of medication errors is still a common occurrence. Whether attitude and intention towards medication administration error reporting connect to actual reporting behaviours remain unclear. Design: This study used a cross-sectional design with self-administered questionnaires, and the theory of planned behaviour was used as the framework for this study. Methods: A total of 596 staff nurses who worked in general wards and intensive care units in a hospital were invited to participate in this study. The researchers used the instruments measuring nurses' attitude, nurse managers' and co-workers' attitude, report control, and nurses' intention to predict nurses' actual reporting behaviours. Data were collected from September-November 2013. Path analyses were used to examine the hypothesized model. Results: Of the 596 nurses invited to participate, 548 (92%) completed and returned a valid questionnaire. The findings indicated that nurse managers' and co-workers' attitudes are predictors for nurses' attitudes towards medication administration error reporting. Nurses' attitudes also influenced their intention to report medication administration errors; however, no connection was found between intention and actual reporting behaviour. Conclusions: The findings reflected links among colleague perspectives, nurses' attitudes, and intention to report medication administration errors. The researchers suggest that hospitals should increase nurses' awareness and recognition of error occurrence. Relevance to clinical practice: Regardless of nurse managers' and co-workers' attitudes towards medication administration error reporting, nurses are likely to report medication administration errors if they detect them. Management of medication administration errors should focus on increasing nurses' awareness and recognition of error occurrence.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13071
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    ABSTRACT: Aims and objectives: The purpose of this article was to review the development of the practitioner-teacher model and its use in advancing clinical nursing. Background: The practitioner-teacher role, or the unification model, incorporates clinical practice, teaching, consultation and research responsibilities for nurses serving in advanced clinical roles or as nursing faculty as part of professional nursing practice. The practitioner-teacher role facilitates a practice-academic partnership that can serve as a beneficial way to advance clinical nursing care. Design: An exploratory literature review was conducted combined with review of practitioner-teacher and practice-academic exemplars. Methods: A descriptive review of the practitioner-teacher model of nursing practice reveals that activities of the role include clinical nursing care, serving as a preceptor for nursing students in a focused area of expertise, consulting on patient care issues, presenting in-services and course lectures, and serving as a member of faculty and nursing division committees. Results: The practitioner-teacher role lends itself to promoting practice-academic partnerships that combine clinical nursing care with professional nursing activities. Conclusions: The model of practice, education, consultation and research of the practitioner-teacher position advances practice-academic partnerships. Relevance to clinical practice: The practitioner-teacher model serves to optimise the way nursing practice and academic work together to integrate knowledge, scholarship, service and learning and to advance the profession and the discipline of nursing. This article discusses aspects of the unique practice-academic partnership using the practitioner-teacher model, how the role evolved, and how it can improve clinical nursing care globally.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13017
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    ABSTRACT: Aims and objectives: The aim of this article was to explore whether current quality dimensions for health care services are sufficient to capture how parents perceive and contribute to quality of health care. Background: New quality improvement initiatives that actively involve patients must be examined with a critical view on established quality dimensions to ensure that these measures support patient involvement. Design: This paper used a qualitative and descriptive design. Methods: This paper is based on interviews with parents participating in two experience-based co-design projects in a Swedish hospital that included qualitative content analysis of data from 12 parent interviews in paediatric care. Results: Health care professionals often overemphasize their own significance for value creation in care processes and underappreciate parents' ability to influence and contribute to better quality. However, quality is not based solely on how professionals accomplish their task, but is co-created by health care professionals and parents. Consequently, assessment of quality outcomes also must include parents' ability and context. Conclusions: This paper questions current models of quality dimensions in health care, and suggests additional sub-dimensions, such as family quality and involvement quality. Relevance to clinical practice: This paper underscores the importance of involving parents in health care improvements with health care professionals to capture as many dimensions of quality as possible.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13050
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    ABSTRACT: Aims and objectives: To identify and describe conditions that limit or support patients, with alcoholic liver disease after surviving alcohol-induced hepatic encephalopathy, ability to cope with current and potential physical and psychosocial problems - in interaction with professionals and relatives - and to recommend appropriate interventions. Background: Alcoholic liver disease patients surviving alcohol-induced hepatic encephalopathy have significantly impaired quality of life. Internationally, there is a lack of knowledge about the conditions that affect alcoholic liver disease patients' coping and rehabilitation. Design: A grounded theory study. Methods: Semi-structured interviews, conducted with 11 alcoholic liver disease patients who were diagnosed with hepatic encephalopathy. The interview guide was inspired by Richard S. Lazarus's theory of stress and coping. Results: The elements that support or limit alcoholic liver disease patients' ability to cope with physical and psychosocial problems in interaction with professionals and relatives were represented by the core category 'Struggle for preservation of identity as a significant individual'. It was characterised by three categories, which are interrelated and impact upon each other: 'Acknowledgement', 'Struggle to maintain control' and 'Achieving a sense of security'. Conclusion: Alcoholic liver disease patients experience a struggle to preserve their identity as a significant individual. It can be assumed that professionals and relatives in their interaction with, and support of, patients should focus on strengthening and preserving patients' identity in the form of acknowledgement, helping alcoholic liver disease patients maintain self-control and providing a safety net so patients feel a sense of security. Relevance to clinical practice: It can be assumed that professionals should support alcoholic liver disease patients' appraisal of, and coping with, physical and psychosocial problems based on acknowledgment, understanding and a sympathetic attitude. Professionals should proactively approach patients when they withdraw. It may be useful for professionals to be aware of alcoholic liver disease patients' individual coping strategies and thereby their individual requirements for professional supportive intervention.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13006
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    ABSTRACT: Aims and objectives: The aim of this meta-analysis was to identify the factors that related to aggression (verbal abuse or physical abuse/assault) perpetrated against the nurse or other health professionals by patients/relatives or staff. In the light of the paucity of systematic reviews on this common issue in nursing, the objective was to present a comprehensive systematic review and meta-analysis of these papers. Background: Aggression towards nurses is common around the world and can be the impetus for nurses leaving the profession or developing anxiety when working in particular settings. Design: Systematic review with meta-analysis. Methods: Meta-analyses were conducted to assess the effect of the factors of gender and context (dichotomised as mental health/psychiatric or nonmental health/psychiatric). The databases of Medline (1966-2015), CINAHL (1982-2015) and PsychInfo (1920-2015). Results: A total of 1571 papers were screened by two reviewers. At the final decision 14 were selected for analysis. A higher proportion of female nurses than male nurses were reported to be the victims of verbal abuse, with the difference in proportions being statistically significant. A statistically significant higher proportion of male nurses than female nurses were reported to be the victims of physical abuse. There was a significantly higher proportion of mental health nurses reported experiencing physical abuse as compared to nonmental health nurses. Conclusions: The analysis reveal female nurses have greater odds of verbal abuse than male nurses and male nurses have greater odds of physical abuse than female nurses. Overall mental health nurses had three times higher odds of physical assault than other nurses. Relevance to clinical practice: In the light of the findings it is recommended organisational support improve in high aggression potential clinical areas and for nursing curriculums to incorporate education about the management of challenging behaviours in undergraduate programmes.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13019
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    ABSTRACT: Aims and objectives: The aim was to describe the experience of living with varicose veins classified according CEAP (clinical class, aetiology, anatomy, pathophysiology) as C4 (eczema or thrombophlebitis) and management of the disease in daily life. Background: Primary chronic venous insufficiencies with varicose veins are a relatively common condition among both men and women. Several studies have shown that quality of life improved after treatment of varicose veins compared to before treatment. This suggests that patients with a milder form of varicose veins such as C4 experience a negative influence on their quality of life before treatment. Design: This is an explorative qualitative study with a phenomenological approach. Method: A purposive sample was used, and 12 in-depth interviews were conducted with persons having superficial venous insufficiency classified C4. A descriptive phenomenological analysis was performed. Results: The essence of the phenomenon of living with varicose veins classified C4 and management of the disease in daily life meant adapting to a life with varicose veins and relieve discomfort from legs with an unfavourable appearance. Coping with discomfort involved dealing with the disease emotionally and finding strategies that helped to relieve symptoms; however, living with 'repulsive' legs was seen as embarrassing, and many found the need to hide their condition. Conclusion: Patients with varicose veins classified C4 had notable symptoms of the disease that affected daily living. This in turn required the use of different coping strategies to manage symptoms, and significant adjustments related to activities and social life were made. Relevance to clinical practice: It seems desirable that patients with varicose veins receive treatment at an earlier stage of the disease and are familiar with the tools and solutions available to alleviate symptoms and avoid a negative impact on daily life.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13023
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    ABSTRACT: Aims and objectives: To describe the incidence of problems associated with the positioning of anaesthetised surgical patients. Background: The positioning of the anaesthetised surgical patient is a complex task. The interdisciplinary nature with several professional groups in a surgical team may lead to conflict between the positioning standards and individual consideration for the patient. Existing knowledge of the relationship between the different positioning forms, surgical team competences and the applicability and availability of positioning equipment is sparse. Design: A descriptive cross-sectional study. Method: An electronic questionnaire was sent to 833 OR nurses employed at four public university hospitals. With 481 responses, a response rate of 57·7% was achieved. Descriptive statistical analyses were performed using the spss software package (version 19.00). Results: Positioning of the patient was found to be particularly difficult for the prone (43·8%), lithotomy (53·4%) and lateral (65·5%) positions. Lack of positioning competences and equipment for arm support, standardised equipment for leg support and standard sizes of OR beds seemed to complicate positioning. Conclusion: Lack of appropriate positioning equipment and positioning competences in surgical teams, combined with the poor availability of positioning equipment in ORs were found to cause problems. Relevance to clinical practice: There is a need for innovative solutions to develop modern forms of positioning equipment allowing individual consideration of the patient. Further research is required on positioning equipment, optimisation of continuity and the establishment of permanent surgical teams.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13000
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    ABSTRACT: Aims and objectives: Although many studies have assessed the efficacy of yoga in older individuals, minimal research has focused on how nurses use yoga to improve sleep quality and to reduce work stress after work hours. We used the Pittsburgh Sleep Quality Index in Chinese and the Questionnaire on Medical Worker's Stress in Chinese to determine the impact of yoga on the quality of sleep and work stress of staff nurses employed by a general hospital in China. Background: Disturbances in the circadian rhythm interrupt an individual's pattern of sleep. Study design: Convenient sampling method. Methods: One hundred and twenty nurses were randomised into two groups: a yoga group and a non-yoga group. The yoga group performed yoga more than two times every week for 50-60 minutes each time after work hours. The NG group did not participate in yoga. After six months, self-reported sleep quality and work stress were compared between the two groups, and then we used linear regression to confirm the independent factors related to sleep quality. Results: Nurses in the yoga group had better sleep quality and lower work stress compared with nurses in the non-yoga group. The linear regression model indicated that nursing experience, age and yoga intervention were significantly related to sleep quality. Conclusion: Regular yoga can improve sleep quality and reduce work stress in staff nurses. Relevance to clinical practice: This study provides evidence that hospital management should pay attention to nurse sleep quality and work stress, thereby taking corresponding measures to reduce work pressure and improve health outcomes.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.12983
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    ABSTRACT: Aim and objectivesTo investigate the perceived experiences and considerations among potential kidney transplantation donors in relation to acceptance or rejection as donors.Background Kidney transplantations are successfully performed in all Western countries, but the prevalence of patients waiting for organs from deceased donors far exceeds the number of organs available. This shortfall has promoted donation by living donors, who enter the donation process with feelings of hope, concern and patience to be accepted or rejected for donation.DesignA phenomenological-hermeneutic approach was applied in the study.Methods Semi-structured interviews were conducted with 16 participants. Data were interpreted and discussed in accordance with Ricoeur's theory of interpretation involving: naïve reading, structural analysis, critical interpretation and discussion.ResultsAccepted donors experienced relief and delight. Reflections were made on being prepared for donation and on the risks involved. Relationships between donors and recipients became closer. Rejected donors experienced frustration and disappointment, including anxiety about the recipient's prospects. Rejected donors reflected on the reason for rejection, and this could include considerations about changes to their own lifestyle. Reactions from relatives had an impact on donors.Conclusions The study concluded that both the accepted and rejected donors were vulnerable and in need of attention, engagement, support and care. The study draws attention to the need for healthcare professionals to be open and sensitive to the donors′ descriptions of their unique experiences of being accepted or rejected for kidney donation.Relevance to clinical practiceNurses should be aware that dialogue with donors, including reflections on experiences, is important to reduce and alleviate vulnerability and to give the best possible support and attention, including the opportunity to promote optimal postdonation outcomes.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13012
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    ABSTRACT: Aims and objectivesTo understand the patients' reasons for returning to the emergency department soon after their discharge from an internal medicine unit and to compare these reasons with the liaison nurse clinician's risk assessment tools used for discharge planning.Background Returns to the emergency departments soon after discharge from the hospital are a recurrent problem. Factors precipitating readmission to hospital have been analysed through the lens of health care providers, but few studies have explored the patients' perspectives on their reasons for returning to the emergency departments.DesignA qualitative, descriptive study.Methods Semi-structured interviews were conducted with a convenience sample of eight patients recruited from a major teaching hospital in Montreal, Canada. Three different data sources were triangulated: patients' perspectives obtained through interviews and data from the tools used by the liaison nurse clinician, the Bounceback Probability Legend and the LACE Index Scoring Tool.ResultsMost patients attributed their return to the emergency department on being discharged too soon, feeling weak at discharge, having limited help at home with managing chronic illnesses and insufficient discharge instructions. participants' reasons for returning differed from those predicted by the liaison nurse clinician's evaluation using the risk assessment tools of each participant's risk of return.Conclusions This study highlights patients' frailty upon discharge from the hospital and their informational need on their health condition and their support need to rely on during convalescence at home. Patient's readiness and concerns were not integrated as part of the liaison nurse clinician's evaluation tools for discharge planning. This led to discrepancies between the perspectives of the patients and the liaison nurse clinician about discharge planning.Relevance to clinical practiceHealth care professionals should evaluate patients' understanding of their illness, their readiness for self-management and work collaboratively with patients to assess concerns before discharge, so that appropriate support can be mobilised to prevent readmission.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13011
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    ABSTRACT: Aims and objectivesTo examine, from the perspective of staff, if obese patients have any additional care needs, and what the impact of these care requirements are on care provision. We have selected obese patients with venous leg ulceration as an example patient population to explore these questions.Background Anecdotal evidence indicates obesity can increase care requirements and have implications for obesity for care provision. However, little research exists nationally or internationally that provides evidence from a health care perspective. Obesity is a contributory causative factor of lower limb ulceration. In addition to affecting the development of venous leg ulceration, obesity may also impact on the care an obese patient may require and receive.DesignQualitative study using semi-structured in interviews and framework analysis.Methods Interviews were conducted with 18 health care professionals and one focus group with 12 health care professionals who cared for patients with venous ulceration. Data were analysed to identify recurring themes relating to the impact of obesity on care provision.ResultsThis study found that the increasing numbers of obese patients with leg ulcers are currently presenting challenges to care delivery in many different ways. There was an impact of obesity on patient experience in terms of dignity, safety and quality. Data indicated that neither hospital nor community care services were adequately set up to meet the needs of obese patients in general.Conclusion Health care providers need to recognise that increasing numbers of overweight and obese patients are presenting challenges to care delivery. The study also indicated the need for senior strategic leadership in planning for meeting the needs of obese patients.Relevance to clinical practiceNursing is well placed to provide specialist support to co-ordinate services for obese/oversize patients if a suitable strategic and leadership role is developed. Nurses are used to offering patients help in areas of health promotion such as smoking cessation. Lessons learnt from this area could be applied to help and encourage staff to support patients with weight management.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13016
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    ABSTRACT: To explore how young ‘expert patients’ living with Cystic Fibrosis and the healthcare professionals with whom they interact perceive partnership and negotiate care. Modern healthcare policy encourages partnership, engagement and self-management of long-term conditions. This philosophy is congruent with the model adopted in the care of those with Cystic Fibrosis, where self-management, trust and mutual respect are perceived to be integral to the development of the ongoing patient/professional relationship. Self-management is associated with the term; ‘expert patient’; an individual with a long-term condition whose knowledge and skills are valued and used in partnership with healthcare professionals. However, the term ‘expert patient’ is debated in the literature as are the motivation for its use and the assumptions implicit in the term. A qualitative exploratory design informed by Interpretivism and Symbolic Interactionism was conducted. Thirty-four consultations were observed and 23 semi-structured interviews conducted between 10 patients, 2 carers and 12 healthcare professionals. Data were analysed thematically using the five stages of ‘Framework’ a matrix-based qualitative data analysis approach and were subject to peer review and respondent validation. The study received full ethical approval. Three main themes emerged; experiences of partnership, attributes of the expert patient and constructions of illness. Sub-themes of the ‘ceremonial order of the clinic’, negotiation and trust in relationships and perceptions of the expert patient are presented. The model of consultation may be a barrier to person-centred care. Healthcare professionals show leniency in negotiations, but do not always trust patients' accounts. The term ‘expert patient’ is unpopular and remains contested. Gaining insight into structures and processes that enable or inhibit partnership can lead to a collaborative approach to service redesign and a revision of the consultation model.
    Journal of Clinical Nursing 10/2015; DOI:10.1111/jocn.13021